Category: Travel NP Advice

• Travel: The best part of working in locum tenens is the travel! I am able to explore different parts of the country without having to pay for anything out of pocket. You get to really explore a town when you live there for several months versus just visiting for 3 days. I have friends and family that live all over, so it’s really nice to be able to meet up with them occasionally.

• Flexibility: Working as a traveling nurse practitioner, I can request as many vacation days off as I want. I usually present these dates to a site before starting, to make sure there are no surprises. I am also guaranteed to have all vacation days off. If I do decide to work on holidays, I am offered holiday pay. If I decide to work four 10 hour shifts or only 32 hours a week, the site will likely accommodate me. 

• Great Pay: By working locum tenens, I make more than I would make working at a full-time job. When I began working locum tenens, I started off immediately making $10/hour more than I did at my perm job. I am also guaranteed paid for any overtime hours worked, which is nice since most salary employees work more than 40 hours a week without overtime pay.
• Learning: Part of the appeal of doing locums is working in various environments. Depending on the type of facility and patient population, I am constantly being challenged and learning something new. The physicians at these sites are often welcoming and open to providing a quick consult if needed.

• Miles/Points: As someone who loves to travel, collecting airline miles and hotel points throughout my locum tenens assignments is a plus. I have joined most reward membership programs, and am constantly accruing miles/points. I am then able to use these miles to fly free during my vacations. In addition, my multiple hotel stays have gotten me top elite status, which comes in handy when I stay at these hotels during my travels abroad (free breakfast and room upgrade perks etc.).

 

What are some reasons you enjoy working locum tenens?

Working as traveling nurse practitioners, we often consider working with government sites because we can use any state license. Some examples include the VA, naval and air force bases, and Indian Health Services (IHS). Unfortunately, government locum tenens assignments have a few drawbacks. The comments below are more specific to VA and military bases (not IHS).

• The pay is usually lower than working in the private sector (including some but not all IHS).
• The time for credentialing is often longer than other jobs – can range from one month to one year!
• Travel benefits are a possibility but not as all-inclusive, as seen with most traveling positions.
• They usually require a 6-month to 1 year commitment.

I had accepted a locum tenens nurse practitioner position working with an air force base in Texas this past summer. I knew someone who had worked there previously, so I was really interested in taking a break from primary care. The job entailed performing physical assessments of air force members transitioning into civilians.

After multiple complex stunts working in California, as I detailed in my blog previously, I was looking forward to something so simple. I lucked out because usually the site requires a 6-month commitment, but since their contract with the agency was going to terminate before the end of the year, they were allowing me to commit for only 3 months.

I even decided that the pay cut was worth it. I was going to be making $10/hour less than I usually make. I even decided that not getting travel reimbursement wasn’t a big deal, nor the fact that I was only getting an $800/month stipend to pay for my apartment. Luckily, Texas has really cheap housing in comparison to other states like California. Yet, it is challenging finding short-term lease apartments for cheap, so I was likely going to spend an extra $300/month out-of-pocket. Call me crazy?!

The agency I was working through, told me credentialing would take only 2-4 weeks. I knew from a few friends that it could actually take much longer than that. After accepting the assignment, I didn’t need to start for another 2 months, so I thought that would be plenty of time. After each month, the agency would tell me that my security clearance didn’t come through yet, and it may be another 2-4 weeks. After 3 months, I decided I did not want to wait anymore. I had friends that were told the same thing before, but their security clearance wasn’t granted until 6 months later!

I was easily able to end my contract since the agency couldn’t follow through with their (2-4 weeks of credentialing) promises. I am not sure if I will try to work with them in the future, as their time frame for credentialing can be unpredictable. My belief that everything at the government level takes so long for no reason was confirmed. In addition, I typically do not like committing to an assignment for more than 3 months. In the future, I wouldn’t mind doing IHS, as their credentialing usually takes 1 month or less.

If you’re interested in working in the government sector, be aware that you likely won’t be able to start right away, unless it is with an IHS.

I originally planned on working in California for about 3 months but ended up being there for almost 7 months. California is so large that it’s impossible to explore the entire state in a short period of time. Also, since the process of getting a California license is so lengthy, job opportunities are always plentiful.

After working in 3 different facilities while in California, I started to wonder if being in California was a curse? Each clinic I worked at was progressively better than the last. However, it was obvious that with the affordable care act, there was a significant increase in patients that needed care, and now had “access” to care. Unfortunately, the majority of community health centers in California are unable to keep up with the demand. Whether it is not having enough providers, enough work space/patient rooms, or enough assistive personnel.

Each facility I worked with in California had very low employee satisfaction rates. As my last assignment in California came to an end, I knew one thing – and that was that I needed to get out of California!

I found myself suddenly become homesick. I had only really been home for a mere 4 days this entire year. I decided to take a few weeks off to hang out at home and spend time with family and friends. As I thought about my next assignment, I knew I wanted to be back on the East Coast. I wanted to be somewhere that I could easily go home for the weekend if I wanted to.

Sadly, I was quickly informed that licenses I thought would only take 1-4 weeks to obtain, would take 2-3 months long. The reason is because now that I have a California license, the board of nursing in other states will want to verify that license. California is known to take several months to endorse a license. Unfortunately for us nurses, they also take several months to verify a license. I could not grasp how this made sense until I saw that California is not part of the nursys network, which usually provides quick online licensure verification.

Luckily I have other state licenses I can use while my new licenses come through. Hopefully they will only need to verify my original license in Florida and not all of my active licenses. I will be sure to keep you informed!

In conclusion, while RN’s that come to California have certainly hit the jackpot, I can easily say that California is not the best place to practice as a nurse practitioner. The pay rates are NOT higher than other states, but the cost of living is much higher, and the outpatient healthcare facilities like to operate as factories. RN’s in California often make as much as nurse practitioners, if not more. This is due to their highly organized unions and variable work settings/shifts. Overall, California is a lovely state and the stressful work environment was balanced out by the beautiful scenery and perfect weather. Do I recommend locum tenens work in California? Yes! Do I recommend permanent nurse practitioner work in California? Only if you manage to find a clinic that allows you to see 18 or less patients a day. Good luck!

When you start working at a new assignment, you can easily be overwhelmed at first. I think the first two weeks are usually the toughest. You are learning a new system, in a new environment, and with new people. After two weeks, you can start judging if the facility you are working with is fair or not.

Some issues I have come across while working as a locums include but are not limited to:

-High patient load with limited time (example: 30 patients a day where new patients are only 15 minute visits etc.)

-Only having 1 medical assistant to help you

-Having 1 patient room to work out of…

-Clinic Manager/Supervisor scrutinizing you

-EHR system that is not so user friendly

 

The list can go on and on. Of course no place is perfect, and I don’t typically expect them to be. However, when my license is on the line, I can get pretty frustrated if the site does not have a good flow. Make sure to express your frustrations to your agency liaison (whether it’s your recruiter or the account manager). They can often help improve your situation by reaching out to their site contact. Also, if you end up wanting to leave an assignment early, at least there will be no surprises.

In one instance, I had a fabulous recruiter in which I confided in her some issues I was having with the clinic manager at one of the sites I was working at. She agreed that the clinic manager had said some distasteful things to me and immediately reached out to her contact at the site. The next day, I already had the clinic manager sucking up to me! Not to mention, my recruiter sent me a $25 giftcard to starbucks to brighten up my day.

I ended up continuing with that assignment and completing my 3 month contract even though I had a confrontation with the clinic manager during my first 2-3 weeks. I was grateful for how my recruiter handled that situation.

On the other hand, I worked at a site that did not follow through with their promises. 75% of the time I only had 1 medical assistant to help me, when I was originally promised 2 (and every other provider had 2). Every other day, I only had 1 patient room to work out of which was ridiculous when you have a full patient load.

I spoke to my agency liaison and she said she would address my concerns. I was once again promised by the agency and site that things would get better. They only got better about 25% of the time.

During my last month, the clinic suddenly wanted to add child wellness exams to my already busy schedule. I refused on the basis that their EHR system required using 11 different templates per each physical, and that California has a lengthy list of requirements for child physicals (including a fluoride application, TB screening, hemoglobin check etc). With me only having 15 minutes for new patients and for adult physical exams, I did not see it possible for me to add child wellness exams to my schedule as well.

At first the site said it was okay, but then they suddenly started putting these child physicals on my schedule. I once again complained about the child physicals, and the site pretty much told me I would have to see them. I contacted my agency and at that point they were more concerned about their relationship with the site than with me.

Since no compromise was reached, I opted to leave the site early, and thus my contract ended. I do not like to leave earlier than originally agreed upon because I understand how much help is needed. However, my priority will always be my patients and my license.

I truly wish my agency had stepped up to support me instead of prioritizing the clinic. Was I truly surprised? No. Yet, I showed you how much influence an agency has in the enjoyment of your assignment and on you completing it as contracted.

Feel free to reach out to me if you need suggestions on which agency to use!